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Am J Transplant. 2019 Oct;19(10):2944-2948. doi: 10.1111/ajt.15398. Epub 2019 May 21.

Evidence of a clinically significant drug-drug interaction between cannabidiol and tacrolimus.

Author information

1
Division of Nephrology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
2
Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
3
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
4
Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Abstract

Cannabidiol (CBD), a major purified nonpsychoactive component of cannabis with anticonvulsant properties, was approved by the U.S. Food and Drug Administration (FDA) in June 2018 as an adjuvant treatment for refractory epilepsy (Epidiolex; GW Pharmaceuticals). CBD is metabolized by cytochrome P450 (CYP)3A4 and CYP2C19 with a growing body of evidence suggesting it is also a potent inhibitor of these pathways. We report for the first time a significant drug-drug interaction between the purified CBD product and tacrolimus. A participant in a CBD clinical trial for epilepsy who was also receiving tacrolimus showed an approximately 3-fold increase in dose-normalized tacrolimus concentrations while receiving 2000-2900 mg/day of CBD. Our report delineates an important concern for the transplant community with the increasing legalization of cannabis and advent of an FDA-approved CBD product. Larger studies are needed to better understand the impact of this drug-drug interaction in solid organ transplant recipients.

KEYWORDS:

alternative and complementary medicine; clinical research/practice; drug interaction; immunosuppressant - calcineurin inhibitor: tacrolimus; immunosuppression/immune modulation; pharmacology

PMID:
31012522
DOI:
10.1111/ajt.15398

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